Vertebral column surgery



See: neurosurgeon or Orthopedic Surgeon? Fusion: There are many different specific techniques to try to fuse vertebrae together. The goal of the lumbar fusion is to have the two vertebrae fuse (grow solidly together) so that there is no longer any motion between them after a discectomy. ( e ortho pod. Com) fusion The most common type is a posterior lumbar interbody fusion (plif). Small strips of bone are removed from the top rim of the pelvis.

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Lower Back pain and Sciatica and m other Home remedies: Pedicle screws and rods, home traction devices Cervical collar therapy and halter cervical traction are sometimes used to reduce cervical vertebrae pain. See: Inflatable traction device. Exercise : Swimming, stretching, t'ai chi see: Ice, heat and medication in Relief below and Home remedies for Back pain Other conservative treatments are listed under Relief and Prevention below. Surgery: Surgery should only be used when a specific problem is identified which cannot be remedied by any other means. Surgery can offer an 80 to 85 chance of improvement, but sometimes surgery can make things worse. It's important to get a second opinion before undertaking surgery. Orthopedic surgeons specializing in spine surgery and neurosurgeons can treat disc herniations, disc degenerations, spinal stenosis and fractures of the spine, slippage of the spine (spondylolisthesis scoliosis, bone tumors of the spine. Only neurosurgeons are trained to perform procedures inside the lining of the spinal canal. Scoliosis and other spinal deformities are still primarily treated surgically by orthopedic spine specialists.

See: guide to spinal injections, radiofrequency ablation (or rfa) uses radio waves to heat up a small area of nerve tissue, destroying the nerves ability to transmit pain signals. It is frequently used for arthritic or inflames facet joints which can cause chronic pain radiating to the buttocks or back of the leg. Typically muscle relaxants and pain medication are used for short episodes of acute back pain. Relief and Prevention below. Supplements: I have a friend that was diagnosed with stenosis, who says taking magnesium supplements worked when epidurals, physical therapy and chiropractors did not. See: Ending Back pain With the help of Magnesium hond from Jigsaw, a manufacturer and, natural Calm / Magnesium Supplement at t, there are a variety of medications, supplements for treating osteoporosis, do it yourself devices: Inversion Table: Allows you to hang upside down or partially. In addition to relieving back pain they claim improved sleep, mental alertness, flexibility and posture. You can increase the effect and get an additional workout by lifting weights while inverted. It is based on the principal that when you invert your body, the amount of weight pulling on each level of your spine is directly proportional to the amount of force needed to produce proper alignment. Here's how it works: The weight of your head exerts just the right amount of pull for your cervical spine.

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Vertebral column - wikipedia


Source: Relief for your aching back at, consumer Reports health Ratings Center, 2009, don't seek chiropractic adjustment if you have osteoporosis or signs or symptoms of nerve damage, such as numbness, tingling or loss of strength in an arm or leg. Stress Reduction: If you believe. Sarno's 1990 best selling book "Healing Back pain: The mind-Body connection", the paracetamol majority of back pain is psychosomatic caused paracetamol by stress. The adult version of children's stomach ache. See stress reduction below. Medication: Anesthetic injections: neurogenic pain: Can be treated with. Epidural Steroid Injections with or without lidocane, narcotics or tranquilizer type substances. Other injections: Selective nerve root block (snrb facet joint block, sacroiliac joint Injections.

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The diagnoses for the angular kyphosis patients included neurofibromatosis-2, congenital dislocations of the spine-2, congenital kyphosis-2, neuromuscular-2, post-laminectomy kyphosis-1, and post-radiation-1. Lastly, the diagnoses for the kyphoscoliosis patients included idiopathic-7, neuromuscular-3, congenital-2, and neurofibromatosis-2. There were 31 pediatric patients (average age 13, range 4-18 years) and 12 adult patients (average age 52, range 20-73). Patients underwent a one-level (n25 two-level (n13 or three-level (n5) posterior vcr. The majority of the procedures (40 out of 43, 90) were performed at the L1 or cephalad region of the spinal cord. The remaining three procedures were performed in the upper cauda equina region (L2 and/or L3). Table 1 includes specific demographic details on all patients, while table 2 includes corresponding radiographic data. Table 1 demographic Data on 43 Patients.

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In 1997, he and. Boachie-adjei (2) further expanded on Bradfords original case series by which they reported on 16 patients undergoing a circumferential vcr. Excellent deformity correction and rebalancing of the trunk was reported with few serious complications. More recently, suk et al reported on a posterior-only approach with a vcr for fixed lumbar spinal deformities (3 as well as for severe, rigid scoliosis. (4,5) They reported excellent surgical correction with minimal long-term complications for lumbar deformities resected around the cauda equina region, with similar results for the thoracic scoliosis patients except for one permanent paraplegia postoperative. To date, no north American clinical series has reported on this technique for the treatment of primarily thoracic-based, severe pediatric and adult spinal deformities.

The purpose of this study was to examine the indications, correction rates, perioperative and postoperative morbidity and complications of an all-posterior vcr approach for the treatment of severe pediatric and adult spinal deformity by a single surgeon. This posterior vcr approach has obviated the need for a circumferential approach in both primary and revision settings for all patients with severe spinal deformities since 2002. Material and Methods, between 20, 43 consecutive pediatric and adult severe spinal deformity patients underwent a posterior-only vertebral column resection (VCR) performed by a single surgeon. Indications for surgery were severe and/or rigid spinal deformity divided into four categories: 1) scoliosis (n7, mean 85, bicarbonaat range 45-150 2) global kyphosis (n12, mean 92, range 70 to 120 3) angular kyphosis (n10, mean 72, range 43 to 135 and 4) combined kyphoscoliosis (n14. The diagnoses honden for the scoliosis patients included idiopathic-4, neuromuscular-1, and congenital-2. The diagnoses for the global kyphosis patients included Scheuermanns-3, congenital-3, and neuromuscular-2, arthrogryposis-1, post-vertebroplasty collapse-1, post-traumatic-1, Klippel-feil-1.


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Although technically challenging, a single stage approach offers dramatic correction in both primary and revision surgery of severe spinal deformities. The ability to treat severe pediatric and adult spinal deformity through an all-posterior vcr approach has obviated the need for a circumferential approach in primary and revision settings. Acceptable spinal deformity correction can be obtained through this all-posterior approach, similar if not superior to patients treated with a circumferential and anterior and separate posterior approach. The use of spinal cord monitoring, especially some type of motor tract monitoring is imperative to maintain neurologic function during these challenging procedures. Introduction, the surgical treatment of severe spinal deformity has traditionally been based on a circumferential approach to the spinal column.

(16,17,20) In a first stage anterior approach, multilevel discectomies and/or corpectomies are performed for release of the rigid spinal column. In addition, anterior spinal fusion is obtained through grafting of the released disc spaces, and/or placement of morselized vertebral body bone back into any corpectomy defects that were performed in anticipation of a circumferential vertebrectomy procedure. Then, either on a same-day or staged basis, a posterior procedure is performed for instrumentation, correction, and ultimate fusion. Concomitant with the posterior approach, posterior releases of the ligaments and facet joints (Ponte or Smith-Petersen type osteotomies) are performed versus a posterior laminectomy and pediclectomy for completion of a circumferential vertebral column resection (VCR) approach. This approach has been the standard of care of severe, rigid spinal deformities for several decades once segmental spinal instrumentation made stable instrumentation constructs possible for the treatment of these severe deformities. Performing a circumferential vcr approach for severe, rigid spinal deformity was first described by Bradford in the late 1980s.(1) he was the first to describe the use of a circumferential vertebral column resection coupled with concave rib osteotomies, convex thoracoplasty, and segmental spinal instrumentation with.

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All patients following surgery were at their saturday baseline (n40) or showed improved sc function (n3 while no one worsened. 2 patients had nerve root palsies postop (unilateral quad deficit in a revision L2 l3 vcr, unilateral foot drop in a revision T12 l1 vcr with preop 4/5 strength) resolving spontaneously 6 months/2 weeks respectively. No patient thus far has required revision surgery for any neurologic, wound, instrumentation, or fusion complication. Conclusion: A posterior-based vcr is a safe but challenging technique to treat severe primary or revision spinal deformities with no spinal cord-related, wound, instrumentation, or fusion complications thus far. Intraoperative scm (especially motor-evoked potentials) is mandatory to prevent spinal cord-related neurologic complications. Précis: The ability to treat severe pediatric and adult spinal deformity through an all-posterior vcr approach has obviated the need for a circumferential approach in primary and revision settings. This is the largest North American series to date of a posterior-based vcr procedure for severe pediatric and adult spinal deformity. Intraoperative use of spinal cord monitoring, (specifically nmep) is mandatory to prevent neurologic complications.

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There were 31 pediatric (ave. Age 13 and 12 adult (ave. Age 52) patients with 19 primary and 24 revision cases. All patients underwent a 1-level (n25 2-level (n15 or 3-level (n5) vcr utilizing pedicle screws, anteriorly positioned cages (n31 and intraoperative spinal cord monitoring. 40 out of 43 (93) were performed at L1 or cephalad in snel spinal cord (SC) territory; the remainder were in the upper cauda equina (L2 and/or L3). Results: The major curve correction was 73 (69) for the s cases, 44 (54) for the gk cases, 48 (63) for the ak cases, and a combined 110 (55) for the ks cases. 7 patients (18) lost intraoperative nmep data during correction with data returning to baseline following prompt surgical intervention.

Blanke, rn, washington University School of Medicine,. Scoliosis Research Society paper 13, russell Hibbs Award, best Clinical Presentation 42nd Annual meeting. Edinburgh, Scotland, september 5-8, 2007, study design: Prospective, clinical series. Objective: to examine the indications, correction rates, and complications of a posterior vertebral column resection (VCR) approach for severe pediatric and adult spinal deformity. Summary of Background Data: The ability to treat severe pediatric and adult spinal deformity through an all-posterior vcr approach has obviated the need for a circumferential anterior and separate posterior approach in both primary and revision settings. To date, no north American clinical series involving primarily thoracic-based deformities has been published on this technique. Methods: Between 20, 43 consecutive patients underwent a posterior-only vcr for severe scoliosis (S) (n7, mean.3, range 45-150 global kyphosis (GK) (n12, stretch mean.5, range 70-118 angular kyphosis (AK) (n10, mean.7, range 44-135 or kyphoscoliosis (KS) (n14, mean total ks 193.7, range 149-275).

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Download this paper as a pdf. Lenke, md, professor of Orthopedic Surgery, chief, division of Spinal Surgery. Director, Spinal Deformity surgery, co-director, Adult and Pediatric Comprehensive spine surgery fellowship. Surgeon-in-Chief at The Spine hospital, new York-Presbyterian/Allen. Brenda sides, ms, washington University School of Medicine,. Linda koester, bs, washington University School of Medicine,. Marsha hensley, rn, shriners Hospital for Children,.

Vertebral column surgery
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